Healthcare Provider Details

I. General information

NPI: 1861177768
Provider Name (Legal Business Name): MAXWELL EDWARD PERELGUT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 MARLTON PIKE E STE 2
CHERRY HILL NJ
08003-2123
US

IV. Provider business mailing address

1910 ROUTE 70 E
CHERRY HILL NJ
08003-2123
US

V. Phone/Fax

Practice location:
  • Phone: 856-746-6280
  • Fax:
Mailing address:
  • Phone: 856-428-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03142900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS045592
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number07650
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: